Chapter 10

Physical and Mental Health

The State of Health: A Global Perspective

• High-Income Nations• Infant mortality rate – number of babies

who die in their first year of life for each thousand births

»Low – about 10 deaths for every 1,000 births

• Life expectancy at birth – number of years people in a society can expect to live

»Longer - on average into their seventies or early eighties

The State of Health: A Global Perspective

• High-Income Nations• Chronic diseases – an illness that has a

long-term development»More prevalent in high-income

countries»Related to problems of aging

The State of Health: A Global Perspective

• Low-Income Nations• Poverty and poor health

»Poverty and malnutrition»Poverty and lack of safe drinking

water»Poverty and poor sanitation

• Acute disease-illness that strikes suddenly»Infectious diseases

Rich and Poor Compared: The AIDS Epidemic

• Social epidemiology – study of how health and disease are distributed throughout a society

• Epidemic – disease that spreads rapidly• AIDS: The Global View• Roughly 36 million cases of HIV globally• Africa – 70% of HIV cases• Worlds poor hit hardest by the AIDS

epidemic

Rich and Poor Compared: The AIDS Epidemic

• Poor nations and AIDS»Poor have weakened health»Poor countries have fewer

resources for education and prevention programs

»Cultural patterns and AIDS

Rich and Poor Compared: The AIDS Epidemic

• AIDS: The United States»United States accounts for 2.5%

of HIV cases»Lower rate than many of the

world’s poor nations»Function of educational

programs»Over two billion spent on AIDS

research»Drug treatment for HIV and

lower mortality

Socialist Systems

• The People’s Republic of China• Government administers health care• Barefoot doctors• Modern scientific medicine• Traditional forms of medicine

»Acupuncture»Medicinal herbs

Socialist Systems

• The Russian Federation• Health care is still mostly under

government control• Doctor’s paid less• Mostly women• Economic decline and declining health

Capitalist Systems

• Sweden• Government run health care system• Funded through taxes• Physicians are government employees• Health care a basic right• Form of socialized medicine

Capitalist Systems

• Great Britain• Socialized system of health care since

1948• Dual system• National Health Service – funded by tax

dollars and covers all British citizens• Private health care for those that can

pay

Capitalist Systems

• Canada• Not state controlled but managed system

of health care• Japan• Physicians and hospitals operate

privately in a market system• Government programs and private

insurance pay the majority of health care costs

Health Care in the United States: A system in Crisis?

• U.S. health care system• Direct-fee system – medical care system

in which patients or their insurers pay directly for the services of physicians and hospitals

• Based on choice• Market based system

The Cost Problem

• Health care cost were 1.2 trillion in 1998

• Six reasons behind the soaring cost of health care

• 1. Spread of private insurance• 2. Specialization of doctors• 3. More technology• 4. Aging population

The Cost Problem

• Six reasons behind the soaring cost of health care

• 5. Lack of preventive medicine• 6. More lawsuits• Controlling Costs• Pre-admission testing• Out-patient treatment• Regulate the length of hospitalization

Who Pays?

• Traditional Private Insurance Programs

• About 71% of the population are covered by traditional insurance

»Eighty eight percent received insurance through an employer

»Twelve percent bought it on their own

Who Pays?

• Health Maintenance Organizations (HMOs)

• Private insurance organizations that provide medical care to subscribers for a fixed fee

• Focus on keeping costs down and on disease prevention

• Managed care• Use of primary care physician

Who Pays?

• Government Insurance Programs• Medicare – part of social security for those

over 65• Medicaid- serves the poor who are

»Pregnant»Blind»Permanently disabled»Elderly»Families with dependent children

The Coverage Problem

• Medical insurance does not cover all the cost of care

• Forty three million Americans lack health care insurance

Health: Class,Ethnicity, and Race

• Health follows wealth-ability to pay»Income and access to health

care»Difference in the environment of

the rich and poor and health• Race and health

»Race and poverty rate»Prenatal – care »Racial bias and health

Health: The Importance of Gender

• Gender affects health in a number of ways

»How culture defines masculinity

»Ignoring women’s health needs within the health care system

»Ideas about gender affect health care research

Health: The Importance of Gender

• An Illustration: Eating Disorders• Anorexia nervosa • Bulimia• Function of how culture defines women

in terms of physical attractiveness»Media based image of

thinness and beauty

People with Disabilities

• Disability – physical or mental condition that limits a person’s everyday activities

• Impairs the functioning of the brain or body

• Disability becomes a master status»Overlook a persons ability and

only see the disability• Legislation

»Americans with Disabilities Act

Mental Health and Illness

• Mental disorder – psychological or behavioral condition that reduces a person’s ability to participate in everyday life

• Mental disorders are common»About half of adult Americans

suffer from some form of problem during there life time

»Mild to sever

Types of Mental Disorders

• Classifications of disorders prepared by American Psychiatric Association

• DSM IV – Diagnostic and Statistical Manuel of Mental Disorders

• Many disorders have both biological and social causes

Mental Illness: A Myth?

• Thomas Szasz – mental illness is a myth• Mental illness is relative• Based on cultural standards• Label behavior and people crazy

Mental Illness: Class, Race, and Gender

• Mental Health and Class• Robert Faris and Warren Dunham study

(1939) – poverty and mental illness link»Poverty and stress and social

isolation that can create mental disorders

• Biology and stress and mental disorders• Disorders and the drift into poverty

Mental Illness: Class, Race, and Gender

• Mental Health, Race and Ethnicity• African Americans • Comparable rates to whites when

controlling for social class»Poverty and its impact on

mental health• Hispanic• Low rates of mental illness

»Culture»May not seek treatment

Mental Illness: Class, Race, and Gender

• Mental Health, Race and Ethnicity• Native Americans• Have higher rates rates for

»Alcoholism»Suicide»Mental illness

• In part a function of poverty and alienation

Mental Illness: Class, Race, and Gender

• Mental Health and Gender• Men and women have about the same

incidence of mental illness• Women more likely to be labeled ill for

not following conventional roles• Men and masculinity play a role in the

illness of men

Treatment Strategies

• Treating the mentally ill is a recent phenomena

• Use of mental hospitals• Psychotherapy – or talk therapy• Psychoactive drugs• Community Mental Health Centers

Construction Act 1963• Deinstitutionalization - from hospitals to

the community

Structural-Functional Analysis: Health and Social

Roles• Society as a complex system of roles

and responsibilities• Illness is a problem because people can

not fulfill their roles• Sick role and mental health• Changes in other social institutions lead

to problems of health

Symbolic- Interaction Analysis: The Meaning of

Health• The social construction of health and

illness• Health and illness is socially defined and

changes over time• Social definitions may affect how people

approach disease and illness• Social definitions may affect how people

feel

Social-Conflict Analysis: Health and Inequality

• Inequality and health• Wealth and the access to health• Capitalism, and the focus on profit over

health care needs

Conservatives: Free-Market Care

• Favor a free market approach to health care

• Competition improves value for consumers

• Competition leads to innovation and improvements in the health care industry

• Individual responsibility for one’s health

Liberals: Government Care

• Health care as a right• Combination of health care for profit

with access for all Americans• Some form of Government involvement

to insure access to health care

Radicals: Capitalism is Unhealthy

• To improve health one must:»Remove the profit motive from

health care»Replace capitalism with

socialism